The present invention relates generally to laser devices and biomedical applications thereof. More specifically, the invention relates to setting-up a laser-based system in preparation for performing a myringotomy in an ear without the need for anaesthesia.
Myringotomy is a widely-performed procedure used in the treatment of xe2x80x9cOtitis Mediaxe2x80x9d-acute inflammation of the middle ear. Typically, it involves a surgical procedure whereby the surgeon performs a tiny incision of the eardrum in order to enable the drainage of fluids that accumulate in the eardrum. The incision in the eardrum must remain open and thus an open drainage ring is placed in the incision to prevent rapid healing and occlusion of the incision. This surgery is done under general anaesthesia.
Over the last few years surgeons performed myringotomy surgery using a pulsed CO2 laser. The advantage of the pulsed CO2 laser is its generation of thermal heat resulting in delayed healing of the incision of the eardrum. The incision remains open for approximately 3-6 weeks without the aid of an open drainage ring. Both the incision diameter and laser pulse time duration affect the incision healing time. Typically, the incision diameter is approximately 1 mm and the laser pulse time duration is 0.1 second at a 3-5 Watt power. This surgical technique is generally performed under anaesthesia, because the surgery uses a xe2x80x9cdefocusedxe2x80x9d beam that does not account for a child""s unexpected movement.
There is a need to perform the myringotomy procedure more accurately without the need for anaesthesia. Moreover, there is a need to perform the myringotomy on the tympanic membrane of the child""s ear drum such that any sudden, unexpected movement of the child""s head will not adversely affect the carrying out of the myringotomy. The present invention, as described as follows, provides such an improved myringotomy procedure in children without anaesthesia.
A common problem in systems having an optical imaging system for providing a focusable image of a target using while also providing a laser directing optical system for directing a surgical and or aiming laser beam at the same target is that the co-focusing action usually involves a system for coordinating the moving of at least some optical components of both the imaging optical system and the laser directing optical system. Such coordinated movement mechanisms are expensive, difficult to construct and maintain and may frequently become un-coordinated.
There is thus a need for hand held otoscope for myringotomy and other applications which has a simple optical system which does not require coordinated moving of different optical components while still enabling the user to focus an aiming laser beam and monitor the focusing and aiming action thereof on a display prior to activating the surgical laser beam. The present invention, as described as follows, provides an improved myringotomy device for use in performing myringotomy in children and adults without anesthesia.
One aspect of the invention relates to a method and apparatus suitable for carrying out laser surgery, such as for performing a myringotomy without the need for anaesthesia. The apparatus includes focusable imaging laser otoscope having a single focusing mechanism which enables focusing both the imaging optics and the laser focusing optics without requiring coordinated moving of the imaging optical components and the laser focusing optical components, enabling the user to focus an aiming laser beam and monitor the focusing and aiming action thereof on a display prior to activating the surgical laser beam.
Another aspect of the present invention is a sensor attached within the apparatus for sensing electromagnetic radiation emissions emanating from the target area in response to the surgical laser beam or the aiming laser beam striking the target area and for indicating the penetration of the target area.
Yet another aspect of the present invention is a system including a sensor attached within the apparatus, and a processing unit connected to the sensor and to the surgical laser. The sensor senses electromagnetic radiation emissions emanating from the target area in response to the surgical laser beam or the aiming laser beam striking the target area. The sensor produces a signal which is processed by the processing unit for automatically detecting the penetration of the target area. The processor unit controls the surgical laser and automatically stops the lasing of the surgical laser upon detecting the penetration of the target area.
There is therefore provided, in accordance with a preferred embodiment of the present invention, an apparatus for performing laser surgery without the need for anesthesia. The apparatus includes a housing, an end member movably disposed within the housing, an imaging device attached to the housing for producing an image of a target area, an illuminating system attached to the housing for illuminating the target area. The apparatus further includes a speculum having a longitudinal axis, a first end and a second end. The second end of the speculum detachably attached to the end member. The apparatus further includes an optical system attached to the housing and having a main optical axis coaxial with the longitudinal axis of the speculum, for directing a surgical and/or an aiming laser beam from a laser source through the housing and the speculum to strike the target area, and for directing image forming light rays to project an image of the target area onto the imaging device such that when the image of the target area is focused, the surgical laser beam and/or aiming laser beam are also focused on the target area. The apparatus further includes a focusing assembly attached to the housing and to the end member for adjustably moving the end member and the speculum relative to the housing to focus the image of the target area.
There is also provided, in accordance with a preferred embodiment of the present invention, an apparatus for performing laser surgery without the need for anesthesia. The apparatus includes a housing having an end, an imaging device attached to the housing for producing an image of a target area, an illuminating system attached to the housing for illuminating the target area. The apparatus also includes a speculum having a longitudinal axis, a first end and a second end. The second end of the speculum is detachably attached to the end of the housing. The apparatus also includes an optical system attached to the housing and having a main optical axis coaxial with the longitudinal axis of the speculum, for directing a surgical and/or an aiming laser beam from a laser source through the housing and the speculum to strike the target area and for directing image forming light rays to project an image of the target area onto the imaging device such that when the image of the target area is focused, the surgical laser beam and/or aiming laser beam are also focused on the target area.
Furthermore, in accordance with another preferred embodiment of the present invention, the speculum is exchangeable with any selected one of a plurality of specula, each one of the plurality of specula having different dimensions. The image of the target area is focused by selecting a suitable speculum out of the plurality of specula.
Furthermore, in accordance with another preferred embodiment of the present invention, the laser source is connected to the housing through a scanner for scanning the surgical laser beam and/or the aiming laser beam along a portion of the target area.
Furthermore, in accordance with another preferred embodiment of the r present invention, the scanner is a flashscanner or a silktouch scanner.
Furthermore, in accordance with another preferred embodiment of the present invention, the laser source includes a pulsed or a continuous laser.
Furthermore, in accordance with another preferred embodiment of the present invention, the laser source further includes an aiming laser.
Furthermore, in accordance with another preferred embodiment of the present invention, the laser source includes a surgical laser coupled to the optical system by an optical fiber.
Furthermore, in accordance with another preferred embodiment of the present invention, the surgical laser is a pulsed laser or a continuous wave laser.
Furthermore, in accordance with another preferred embodiment of the present invention, the surgical laser is selected from a pulsed CO2 laser, a continuous CO2 laser and an erbium laser.
Furthermore, in accordance with another preferred embodiment of the present invention, the aiming laser beam is produced by an aiming laser source attached within the housing. The aiming laser source includes an aiming laser and coupling optics for combining the aiming laser beam with the surgical laser beam. The optical system includes a dichroic beam combiner for combining the surgical laser beam and/or the aiming laser beam with the image forming light rays.
Furthermore, in accordance with another preferred embodiment of the present invention, the illuminating system includes a non coherent light source coupled to an optical fiber bundle for providing an illuminating beam directed towards the target area.
Furthermore, in accordance with another preferred embodiment of the present invention, the optical system includes a dichroic beam combiner and a beam splitter for combining the surgical laser beam and/or the aiming laser beam with viewing rays directed by the optical system towards the imaging device and with the illuminating beam.
Furthermore, in accordance with another preferred embodiment of the present invention, the illuminating system includes a non coherent light source, an illuminating member attached to the housing and an optical fiber bundle. The optical fiber bundle has a first end optically coupled to the non-coherent light source and a second end disposed within the illuminating member to provide an annular illuminating system at an end of the illuminating member facing the target area.
Furthermore, in accordance with another preferred embodiment of the present invention, the aiming laser beam is produced by an aiming laser source attached within the housing.
Furthermore, in accordance with another preferred embodiment of the present invention, the aiming laser source includes an aiming laser and coupling optics for combining the aiming laser beam with the surgical laser beam.
Furthermore, in accordance with another preferred embodiment of the present invention, the aiming laser is a diode laser.
Furthermore, in accordance with another preferred embodiment of the present invention, the imaging device is a charge coupled device or a video camera.
Furthermore, in accordance with another preferred embodiment of the present invention, the apparatus further includes a display device for displaying the image of the target area to a user.
Furthermore, in accordance with another preferred embodiment of the present invention, the surgical laser beam has a power level and reflects of the desired target area. The apparatus further includes a sensor arranged in a path traveled by the reflected surgical laser beam the sensor detects changes in the power level reflected off the desired target area, the sensor indicating when the power level being reflected is such that the penetration of the desired target area has occurred.
Furthermore, in accordance with another preferred embodiment of the present invention, electromagnetic radiation emissions emanate from the target area in response to the surgical laser beam or the aiming laser beam striking the target area and the apparatus further includes a sensor arranged in a path traveled by the electromagnetic radiation emissions, the sensor detects changes in the electromagnetic radiation emissions from the target area, the sensor indicating when the electromagnetic emissions are such that penetration of the target area has occurred.
Furthermore, in accordance with another preferred embodiment of the present invention, the surgical laser beam has a power level and reflects of the target area. The apparatus further includes a sensor arranged in a path traveled by the reflected surgical laser beam. The sensor detects changes in the power level reflected off the target area. The sensor indicates when the power level being reflected is such that the penetration of the target area has occurred.
Furthermore, in accordance with another preferred embodiment of the present invention, electromagnetic radiation emissions emanate from the target area in response to the surgical laser beam or the aiming laser beam striking the target area. The apparatus further includes a sensor arranged in a path traveled by the electromagnetic radiation emissions. The sensor detects changes in the electromagnetic radiation emissions from the target area. The sensor indicates when the electromagnetic radiation emissions are such that the penetration of the target area has occurred.
Furthermore, in accordance with another preferred embodiment of the present invention, the sensor is connected to a processing unit. The processing unit is connected to the laser source for controlling the operation thereof. The processing unit determines from signals produced by the sensor whether penetration of the target has occurred. The processing unit automatically shuts off the surgical laser beam after penetration of the target has occurred.
There is further provided, in accordance with another preferred embodiment of the present invention, an apparatus for performing laser surgery without the need for anesthesia. The apparatus includes a housing, an imaging device attached to the housing for producing an image of a target area, and an illuminating system attached to the housing for illuminating the target area. The apparatus also includes a speculum having a longitudinal axis, a first end and a second end. The second end of the speculum is detachably and movably attached to the housing. The apparatus also includes an optical system attached to the housing and having a main optical axis coaxial with the longitudinal axis of the speculum, for directing a surgical and/or an aiming laser beam from a laser source through the housing and the speculum to strike the target area and for directing image forming light rays to project an image of the target area onto the imaging device, such that when the image of the target area is focused, the surgical laser beam and/or aiming laser beam are also focused on the target area. The apparatus further includes a focusing mechanism attached to the speculum for adjustably moving the speculum relative to the housing along the main optical axis to focus the image of the target area.
There is also provided, in accordance with another preferred embodiment of the present invention, a method for performing laser myringotomy without the need for anesthesia, using a focusable imaging laser otoscope. The otoscope includes a housing, a speculum movable with respect to the housing and an illuminating system attached to the housing. The otoscope further includes a surgical laser source and an aiming laser source connected to the housing, an optical system, and an imaging device attached to the housing for imaging a target area. The otoscope is connected to a display which is connected to the imaging device. The method includes the steps of inserting the speculum into the opening of an ear, displaying an image indicative of the target area on the display, focusing the image of the target area on the display by moving the speculum relative to the housing, directing an aiming laser beam produced by the aiming laser source towards a desired portion of the target area suitable for performing laser surgery, to form an illuminated aiming spot on the desired portion, the spot being visible within the image displayed on the display, adjusting the position of the spot on the desired portion of the target area by suitably moving the otoscope within the ear, and firing a surgical laser beam produced by the surgical laser source towards the desired portion of the target area.
There is further provided, in accordance with another preferred embodiment of the present invention, a method for performing laser myringotomy without the need for anesthesia, using an imaging laser otoscope. The otoscope includes a housing, a speculum detachably attached to the housing, and an illuminating system attached to the housing. The otoscope further includes a surgical laser source and an aiming laser source connected to the housing. The otoscope further includes an optical system and an imaging device attached to the housing for imaging a target area. The otoscope is connected to a display which is connected to the imaging device. The method includes the steps of selecting the speculum from a plurality of specula having different dimensions, attaching the speculum to the housing, inserting the speculum into the opening of an ear, displaying an image indicative of the target area on the display, focusing the image of the target area on the display by moving the speculum within the ear, directing an aiming laser beam produced by the aiming laser source towards a desired portion of the target area suitable for performing laser surgery to form an illuminated aiming spot on the desired portion, the spot is visible within the image displayed on the display, adjusting the position of the spot on the desired portion of the target area by suitably moving the otoscope within the ear, and firing a surgical laser beam produced by the surgical laser source towards the desired portion of the target area.
Furthermore, in accordance with another preferred embodiment of the present invention, the target area is the tympanic membrane of the eardrum of the ear and the image is indicative of the tympanic membrane.
Furthermore, in accordance with another preferred embodiment of the present invention, the surgical laser beam has a power level and reflects of the desired portion. The otoscope further includes a sensor arranged in a path traveled by the reflected surgical laser beam. The sensor detects changes in the power level reflected off the desired portion. The method further includes the step of indicating when the power level being reflected is such that the penetration of the desired portion of the target area has occurred.
Furthermore, in accordance with another preferred embodiment of the present invention, electromagnetic radiation emissions emanate from the desired portion of the target area in response to the surgical laser beam or the aiming laser beam striking the desired portion. The apparatus further includes a sensor arranged in a path traveled by the electromagnetic radiation emissions. The sensor detects changes in the electromagnetic radiation emissions from the desired portion. The method further includes the step of indicating when the electromagnetic radiation emissions are such that the penetration of the desired portion of the target area has occurred.
Furthermore, in accordance with another preferred embodiment of the present invention, the sensor is connected to a processing unit. The processing unit is connected to the surgical laser source for controlling the operation thereof. The method further includes, after the step of firing a surgical laser beam, the steps of the processing unit determining from signals produced by the sensor whether penetration of the target has occurred, and automatically shutting off the surgical laser beam by the processing unit after penetration of the target has occurred.